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Intake&Approval Sheet (FcEI1MIT STAFF ONLY) PE # �• 0 S —Q 5 ° <br /> BUILDING . PLANNtIN <br /> l <br /> intake OK by: Date: Intake OK by: Assign To:�z�� Date: c Zo 2 g <br /> Intake Comments: Intake Comments: <br /> Zone M U. <br /> ❑Make thls a"W"Permit 0 SRC Required(Pre-Insp) Overlay/Agreement <br /> Bidg1TUAddn/Rem Size 'r,j iZeflatin Nonresidential Use v.�� <br /> Garage/Accessory Struct.Size )Z�vt-R A Residential Use t <br /> Number of Stories Proposed No.of Dwelling Units: 1-0 . <br /> Basement ISINo [(Yes, Fin/Unfin Total No.of Dwelling Units: () ' <br /> Type of Construction 1.-6 Planning/Landscape Inspection Required before Final? DYes AllIkNo <br /> Occupancy Group yl/) "in Lieu"Fee:Type: Amount$ <br /> Occupancy Load 30. School Impact Fee: Total $ . <br /> Cert.of Occpuancy Required? Ilo DYes UShell Only Calculated: Credit: <br /> Code Year M021 02018 02015 DEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: Update Existing ONew System ONot Req'd Park Impact Fees for permits applied for after 111/2022: <br /> -• Reason Sprinklers Required: Park impact Fee Total$ ' (net due after credit for existing uses) . <br /> Fire Alarm: 44update Existing❑New System ❑Not Req'd Fee Schedule,Used For Cain Mon(Year):„M ntMuu N n m^nV ^„n u,,,,.,,,.,.....Nv ^n <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req'd for perrriit? Mee Jlo <br /> Add'l RCW.64.55 docs required prior to final? EJYcs Kto Additional Notes: rep/ 1'i uce <br /> VAi:UATION CALCULATION: Total$, /V7 0 <br /> Approved By:��o4/0/,,r Date: 3/2 /Zy <br /> PUBLIC WORKS ' <br /> Intake OK by: Date: _ <br /> �. <br /> • Intake Comments: - IPW Review&Worksheet Needed if: <br /> • ,11:1Sys Day Eval: <br /> Additional Notes: 1 OWater LISewer Cm lstor <br /> t[ITraffic Mitigation Eval, <br /> !Approved By: V( A Date: t. /�., JIJSite Work/Drainage(shown/triggered) <br /> • Ivf"" IDAddress Letter <br /> • <br /> FIkg Di"I'ACRTMVI NT 1 g <br /> )]Backflow Prevention for high hazard: <br /> (dental,medical,animals,mortuary, <br /> Separate 1 Deferred Submittals Required: 'hospital,supportive housing) <br /> moire Sprinklers deFire Alarm [lather: i • <br /> Additional Notes: . Q This Permit is Approved by Public Works ' <br /> • 0 See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: El A Separate PW Permit is Required(Permit#:PW ) <br /> El Review of As-Built Plans-NO FIRE FEE AND ❑is fully digital <br /> U Minimal or No Fire Scope-NO FIRE FEE a Is located in this folder <br /> �5 <br /> J8-Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(iarnwiththrs folder for permit issuance) <br /> Approved By ,S, ,n Date: g,,,2 o2Zot a Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> "Public Works has-no scope on this permit---PW Not Required <br /> ELEGTRICAL/PLUMBING . Additional Notes: <br /> • <br /> Additional Notes: ` <br /> Approved By: Date: Completed By.. g" Date: / 1 I'j(2d z-q <br />